Shedding light on paediatric brain tumours

A common misconception of paediatric brain tumours is that they are similar to those in adults, according to Dr Tang Kok Kee, a neurosurgeon practising at Mount Elizabeth Novena Hospital in Singapore.

“Children cannot be considered as smaller versions of adults because their brains are still developing,” he said. “So childhood brain tumours should be treated differently from those in adults.”

Children are more likely to develop tumours in the lower back of the brain – often referred as infratentorial brain tumours - compared to adults where brain tumours are usually located in the upper section.

The lower back consists of structures that govern our body’s automatic movements: the cerebellum, for example, is responsible for balance and coordination, while the brain stem controls our heart and breathing functions as well as the nerves or muscles used for actions like seeing, hearing, talking and eating.

This explains why infratentorial brain tumours often manifest with symptoms such as walking difficulties, uncoordinated movements, eyesight problems, nausea or vomiting, headaches, difficulty in swallowing and loss of appetite, to name a few.

“But these symptoms may not be so obvious during the early stages of the condition because most of these tumours grow very slowly,” highlighted Dr Tang.

On top of that, children often ignore their early symptoms or are unable to ask for help, he added.

One such case involved a patient treated by Dr Tang. The young boy experienced double vision for a long period of time without complaining about it. In order to see clearer, he would tilt his neck, which led him to develop a neck condition. Eventually, he was diagnosed with a brain tumour.

Another reason why paediatric brain tumours are hard to diagnose is that “children’s brains are still growing, therefore they tend to adjust to the tumour’s expansion more easily than fully-developed brains,” explained Dr Tang.

As a result, it is more likely that brain tumours reach a critical state in children rather than in adults.

Diagnosis is time sensitive

“Diagnosis mostly depends on the presentation of the symptoms,” said Dr Tang.

Acute presentations of brain tumours, usually associated with vomiting or seizures, are much easier to diagnose compared to those with progressive symptoms.

However, acute presentations often require immediate medical attention.

For instance, one of Dr Tang’s patients entered into a coma within 15 minutes of complaining about a headache.

During such time-sensitive situations, a quick diagnosis is crucial. A CT scan is the recommended tool as it “is an effective diagnostic method to rapidly scan for brain tumours,” said Dr Tang.

When time is not of the essence, however, using an MRI is the safest way to make a diagnosis.

“MRI is a better option compared to CT scan because it involves no radiation and gives a very clear and detailed picture of the brain structure,” he explained.

Treating paediatric brain tumours

Treatment options for paediatric brain tumours depend on the age of the child.

Typically, the mainstay treatment for children of all ages is surgery, according to Dr Tang.

“Surgery allows surgeons to perform a total resection of the tumour, which completely removes it, thus providing patients with better prognosis,” he said.

Surgery is done to treat both benign tumours, such as pilocytic astrocytoma, and malignancies like medulloblastomas.

However, total resection is not viable when a tumour is too large or close to vital nerves or it has spread to surrounding parts of the brain.

In such cases, surgery is still performed to remove as many tumour cells as possible, relieving brain pressure and symptoms.

“It is a judgment call,” said Dr Tang. “We must know when to stop because continuing to resect the tumour may cause serious damage to the patient’s brain function.”

In some clinical scenarios, surgery can be followed by chemotherapy, radiotherapy or both treatments in order to eliminate the remaining tumour cells.

While certain tumours, such as germ cell, do not require surgery, but can be treated using chemotherapy or radiotherapy.

However, Dr Tang warned that radiotherapy is not indicated for children younger than three.

“Radiation could affect the cognitive function of a growing child’s brain,” he explained. “This increases the risk of developing intellectual disability.”

Dr Tang Kok Kee is a neurosurgeon currently practising at Gleneagles Hospital and Mount Elizabeth Novena Hospital in Singapore. He has special interests in paediatric neurosurgery such as paediatric brain tumours and paediatric spinal conditions. 

Kk Tang Brainspine Surgery
38 Irrawaddy road
#10-28/29
Mount Elizabeth Novena Specialist Centre
Singapore 329563
Tel: (+65)  6339 0528

K K Tang Adult & Paediatric Neurosurgery
6A Napier road
#01-32
Gleneagles Annexe Block
Singapore 258500
Tel: (+65) 6339 0528